Questions for Statia and Edith Schippers

Serious questions should now be asked about the way the health insurance and hospital system is run on the islands of the Caribbean Netherlands. The Dutch Minister of Public Health Edith Schippers has been asked to trim the health insurance package for the islands. It is absolutely time she looked at the costs or more precisely, at the way the treatment system is administered by some of her civil servants.

In the Netherlands, each citizen is required to pay for health insurance. Failure to do so results in fines. No dough, no show! However, on Statia a residence card is all that is needed to get free medical treatment; this philosophy is excellent but expensive. It almost mirrors the national insurance facilities in the United Kingdom (UK) and Canada.

What about the off-island medical treatment in Colombia and Guadeloupe? Whereas I cannot speak for the linguistic mess of the latter, I can add my personal experience of the former.

Medical facilities in Medellin are excellent and internationally recognised for the high quality treatment they provide. Patients that fly out to Medellin are treated by the very best doctors and surgeons as well as afforded almost VIP clinical status as regards nursing facilities and accommodation. Cleanliness is observed in military fashion 24 hours a day. Furthermore, the ratio of medical staff to patients is four to one.

So, why should the minister fix that which is not broken? But, there is something broken. The service provided by the island administration that runs this off-island medical tourism needs vast improvement. For example (and a bit like Columbus before), patients sometimes arrive at hospital not knowing where to go or who will greet and treat them. Their disease and symptoms have not been communicated by the insurance company. The first question the Colombian doctor asks the patient is often, “What is the matter with you?” A waste!

Worse still, MRI scans and x-rays are often not sent by the insurance department or given to the patient to accompany him or her. Such expensive diagnosis tests are, therefore, repeated in Medellin and add to the length of the patient’s stay in the country; moreover, those MRI scans were acquired by patients travelling to St. Maarten beforehand. Travel and overnight stays on St. Maarten for something that will not be used is once again a complete waste of public money.

Once the hospital patient finally departs for Colombia, he will discover that his daily allowance of US$25 will not go far. But, what is far is the distant location of the hotel booked by the insurance department for the overnight stay in Curaçao. A single taxi ride from Curaçao airport to downtown hotel will cost $25 in each direction. This is unacceptable and the misery is made even more evident by the departure tax that the patient has to fork out from his or her purse. This amounts to $60 for all the flights in one direction.

The patient is, therefore, obliged to pay $110 each to get to Medellin. Breakfast at stop-over hotel is not included and if daily allowances are not paid on time as is often the case, hardship results.

Nevertheless, hotels in Medellin are very comfortable but once again, many miles from the hospital. This adds to the cost since a return taxi ride amounts to approximately $30 in rush hour. For the patient and companion, this is not such a problem because one free return taxi ride is provided per day. But, this does not change the fact that the health insurance has to pick up the long distance taxi bill.

The big sting in the tail is the return flight. Once the Colombian doctor has given the “okay” to return to the respective BES Island, it can take another eight days before the patient can leave. This is because the insurance department on Statia is too slow and inefficient.

My experience of this costly delay is not uncommon. Having informed the Statia insurance department that the patient was okay for travel by the doctor at 14:00 of a Thursday, four working days were required to produce the travel booking and that travel booking was for a flight a full week later on Friday of the following week!

One of the reasons for this delay is that only low cost flights are booked (whilst slightly more expensive alternative flights and routes are available). The whole travel side is a disaster and costs the Dutch Ministry of Health many extra days of hotel accommodation and daily allowances through this false economy. More significantly, it also robs the island development of absent personnel who contribute to the economy or running of the island and robs families of loved ones.

Some patients and companions are stranded in Colombia for many months without a logical programme of treatment that allows them to return home when and where necessary. It is a scandal!

I know it is hard on these islands for civil servants to perceive citizens as customers – even though the public pays for their salaries. However, in this case, an immediate and complete review of the system and its workings is required. A quality improvement process is clearly overdue.

By my own calculations, the budget for off-island medical treatment could be reduced by 25 per cent. In reading this letter, the Health Minister, therefore, needs to shake up her own people as well as the budget that provides such lousy services. But, will Edith Schippers take note?